FOSSM Guideline Modeling Tools
Free and Open Source Enabling Technologies for Patient-Centric, Guideline-Based Clinical Decision Support: A Survey.
Turchin A, Kolatkar NS, Pendergrass ML, Kohane IS. Medical Informatics on the Internet in Medicine. 2007 Jun;32(2):93-102.
Question: What is the current state and future trend of Free and Open Source Software modeling tools to create clinical guidelines suitable for clinical decision support software?
Method: Searched PubMed, "Major biomedical informatics websites", the Internet, as well as relied on the authors' own knowledge to find suitable systems.
Outcomes: Clinical Practice Guidelines (CPG) can improve the quality of healthcare. The are an important component of computerized medicne. However, they are not currently in widespread use. What is needed are tools to help integrate them into clinical work flow. These tool need to be "affordable, adaptable, and interoperable." Such aspects not found in proprietary softeware, but are found in Free and Open Source software. The authors then provide a brief explanation of Free and Open Source (FOS), its development community, business model, and proponents.
The majority of the article considers the main concerns with representing CPG's in software. It lists various FOS tools that can help and briefly describes their use and fundamentals. Some of these tools I list below:
Terminology Standards that are FOS, or that should be considered for use are: SNOMED-CT, LOINC (free but not open source), UMLS, and OpenGALEN.
Data Exchange Standards that are FOS, or that have FOS tools are: Hl7 and DICOM, and ISO/IEEE 11073. While ISO/IEEE 11073 is not FOS, it has some FOS tools to check for compliance. The authors also include a list of FOS tools to help with these data exchange standards.
Health Record Standards that are FOS are: HL7's RIM, CDA, EHRcom, OHF, OpenEHR, and EGADSS. The authors include information about FOS tools that can help with these.
FOS Guideline Modeling Tools: Model Centric tools, that help domain experts create CPG's, include: Protege is mentioned along with its fundamental approach and projects. AsbruView allows those with little training to compose in the Asbru language. Tallis tool is based on the PROforma language.
Document Centric Tools, which help create CPG's from documents, include: GEM Cutter helps translate text into Guideline Elements Models. DELTA/A allows for CPG's documents placement into XML. Stepper CPG's creation into XML or even code. Uruz web based guideline tool based on Degel.
Main Result: There are many sophisticated FOS tools for creating CPG models for decision support. Some are successful because of the developer community, but are not widely used because of the few clinicians using the tools. While there was a lack of standards in the past, there are more people heading toward standard terminologies, communication, and architectures. Nature language and machine learning techniques are beginning to help extract information from text. FOS is growing in this area, has learned from its mistakes and successes and will likely help provide for future CPG use in decision support
Commentary: While I can not vouch for the veracity of the information, it is nice to see these sorts of lists as they can really help one begin to research these tools and standards (FOS or others.) However, this article goes much further helping to show one how each tool fits into the over all framework of the process. I find the authors' thoughts on FOS's strengths over proprietary software as well as future prospects interesting, but perhaps not well supported in the article. As a survey I found it brief, although dense, but to the point.
I will be adding to this space in the next couple of days.
--John Norris 23:26, 30 January 2008 (CST)
